2.

1 Lesson Objectives Upon completion of this lesson, you will be able to: Perform proper procedures for hand hygiene. 2.2 Introduction Hand hygiene is the most important and most basic technique in controlling and preventing the spread of infection in health care facilities. Hand hygiene refers to hand washing (the use of soap and water), antiseptic hand washing (the use of antiseptic soap), antiseptic hand rub (the use of an alcohol-based product), and surgical hand antisepsis (the use of an antiseptic detergent preparation preoperatively). Surgical hand antisepsis is not covered in this module. The purpose of hand hygiene is to remove soil and transient microorganisms from the hands and areas around the nails and to reduce total microbial counts over time. Hand washing is a vigorous, brief rubbing together of all surfaces of the hands lathered in soap, followed by thorough rinsing. The recommended duration for lathering hands is at least 15 seconds. A tip is to sing the "Happy Birthday" song twice; this lasts about 15 seconds. Antiseptic hand rubs involve the use of alcohol-based waterless antiseptics that offer more effective germicidal activity than either plain soap or antimicrobial soap and water. Contaminated hands are the prime cause of transmission of infection. Hand hygiene is not optional. It is a critical responsibility for all health care workers. 2.3 Delegation Hand hygiene involves a set of basic procedures that should be performed correctly by all caregivers. If you observe other caregivers or family caregivers incorrectly cleansing their hands, reinforce the importance of the technique and correct procedural steps. Observe the consistency and thoroughness of staff in washing or disinfecting hands. 2.5 Hand Hygiene Guidelines The Centers for Disease Control and Prevention (CDC) hand hygiene guidelines suggest the following: When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with soap (either non-antimicrobial or antimicrobial) and water for at least 15 seconds. If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating the hands in the following situations: Before having direct contact with patients Before putting on sterile gloves and before inserting indwelling urinary catheters, peripheral vascular catheters, or other invasive devices

After contact with a patient's intact skin (e.g., when taking a pulse or blood pressure, and lifting a patient) After contact with body fluids or excretions, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled When moving from a contaminated body site to a clean body site during care After contact with inanimate objects (including medical equipment) in the immediate vicinity of a patient After removing gloves You may also wash hands with an antimicrobial soap and water in these situations. The use of alcohol-based hand rubs is recommended by the CDC (when hands are not visibly soiled) to improve hand hygiene practices, protect health care workers' hands, and reduce transmission of pathogens to patients and personnel in health care settings.

2.7 Assessment Inspect your hand surface for breaks or cuts in skin or cuticles. Avoid long or artificial nails. Report and cover any skin lesions before providing patient care. Open cuts or wounds can harbor high concentrations of microorganisms. Agency policy may prevent nurses from caring for high-risk patients if open lesions are present on hands or if artificial or long nails are worn. Artificial nails increase the microbial load on hands. Note condition of nails. Be sure fingernails are short, filed, and smooth for easier cleaning. Subungual region (beneath fingernails) harbors microorganisms. Natural nails should be no more than 1/4 inch long when caring for high-risk patients. Inspect the hands for visible soiling. This determines the need for hand washing rather than using a alcohol based hand rub. 2.9 PlanningEquipment Depending on the method used for performing hand hygiene, the following items will be necessary: Hand washing Easy-to-reach sink with warm running water Antimicrobial or nonantimicrobial soap Paper towels or air dryer

Disposable nail cleaner (optional) Antiseptic hand rub Waterless alcohol-based product 2.10 PlanningExpected Outcomes Expected outcomes focus on preventing the transmission of infection: Hands and areas under fingernails are clean and free of contaminants. 2.14 Evaluation Your success at practicing infection-control techniques is measured by determining whether the goals for reducing or preventing infection are achieved. When performing personal hand hygiene, you should evaluate the following: Inspect the surfaces of your hands for obvious signs of soil or other contaminants. Inspect the hands for dermatitis or cracked skin.
2.15 Unexpected Outcomes

Unexpected Outcome The hands or areas under the fingernails remain soiled.

Intervention

Repeat hand washing.

Unexpected Outcome The repeated use of soaps/antiseptics may cause dermatitis or cracked skin.

Intervention

Rinse and dry the hands thoroughly. Avoid excessive amounts of soap/antiseptic, try various products, use hand lotions/barrier creams, or wear gloves. (This should be temporary because glove wearing can increase bacterial growth and may increase the incidence of latex allergies.)